Pilot 1
Amit Mathur, MD, MS
Section of General Surgery
Department of Surgery
University of Michigan
amitmath@med.umich.edu
Dr. Mathur is currently a health services research fellow in transplantation at the University of Michigan. He is working with the Scientific Registry of Transplant Recipients on several projects. His research focuses on disparities in access to and outcome from liver transplantation, disparities in hepatocellular carcinoma care, transplant finance, clinical transplantation and hepatobiliary surgery. Dr. Mathur received a M.S. degree in Health and Health Care Research through the Robert Wood Johnson Clinical Scholars Program and the University of Michigan School of Public Health in 2009. He is supported by the Frederick A. Coller Society Surgical Research Fellowship, an institutional NIH T32 training grant in Surgical Oncology as well as the NIH Loan Repayment Program through the National Center for Minority Health Disparities. He is also principal investigator on a Pilot Project grant from the University of Michigan Center for Integrated Approaches in Health Disparities.
Dr. Mathur plans on a career as an academic transplant surgeon.
My research is currently focused on understanding the role of gender, race, and ethnicity on access to and outcomes from liver transplantation. Successful access to appropriate end stage liver disease and liver transplant care requires the successful navigation around several barriers created by the health care system and sociodemographic context. We aim to determine how sociodemographic factors affect access to liver transplantation for candidates who have been accepted on the liver transplant waiting list, and to understand the mechanism of any health disparities that arise in the transplant process. We also aim to determine the mechanism of marginal outcomes previously noted among minority liver transplant candidates.
ABSTRACT
Understanding Racial and Ethnic Disparities in Access to and Outcome from Liver Transplantation
Specific Aims:
Each of the aims will utilize data from the Scientific Registry of Transplant Recipients (SRTR), a nationwide population-based transplant registry. Through the SRTR, patients are essentially followed from the date of wait listing to death. Aim 1. Impact of MELD system on race/ethnicity-specific liver transplant rates: The primary objective of the Aim is to determine the impact of liver allocation by Model for End Stage Liver Disease (MELD) on the presence of racial and ethnic disparities in access to liver transplantation in the United States. Results will be compared with the pre-MELD era. Aim 2. Examining inactivation rates by race/ethnicity: In this Aim, we will compare, by race/ethnicity, rates of inactivation from the liver transplant waiting list. Inactivation may occur if patients are unable to complete the requirements of maintaining active status on the list, including failure to update diagnostic testing, interval psychosocial problems that arise after waitlisting, or the development of infections. Since patients cannot be allocated a deceased-donor organ while inactive, being inactivated is a major barrier to receiving a liver transplant. Inactivation rates may be related to an underlying racial/ethnic disparity. Aim 3. Race/ethnicity and liver transplant donor quality: In the third Aim, we will determine if inferior post-liver transplant graft and patient survival for minorities is associated with access to quality donor organs. Minorities have inferior post-transplant outcomes. Reasons for this difference are unknown, but a novel theory is that minority liver transplant recipients may bear the burden of receiving the poorest quality organs.